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Release 5

This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

8.13 Resource Account - Content

Patient Administration icon Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Device, Patient, Practitioner

A financial tool for tracking value accrued for a particular purpose. In the healthcare field, used to track charges for a patient, cost centers, etc.

8.13.1 Scope and Usage

The Account resource acts as a central record against which charges, payments, and adjustments are applied. It contains information about which parties are responsible for payment of the account.

While the Account does conceptually have a balance, expressing that balance directly as a resource property is challenging due to the complexity of pricing contracts. An operation to retrieve the current balance of an account is in consideration as future work.

8.13.2 Boundaries and Relationships

The Account itself does not include information about the charges, payments or adjustments, but rather those resources, such as ChargeItem point to the account to which they apply. Payment and adjustment resources have not yet been developed.

8.13.3 Background and Context

The Account resource can be considered a "bucket" to which ChargeItem resources are linked. These charges are processed by a billing system, which determines the responsible parties for the balance of the account. The billing system then submits claims or sends statements to the appropriate parties. Once payment is received, an adjustment is applied to the Account. The internal calculation of balances and allocation of responsibility is expected to be internal to the billing systems. Only the inputs and outputs of the billing process is communicated in the relevant financial FHIR resources.

8.13.4 References to this Resource

8.13.5 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Account TUDomainResourceTracks balance, charges, for patient or cost center

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierAccount number

... status ?!Σ1..1codeactive | inactive | entered-in-error | on-hold | unknown
Binding: Account Status (Required)
... billingStatus Σ0..1CodeableConceptTracks the lifecycle of the account through the billing process
Binding: Example Account Billing Statuses (Example)
... name Σ0..1stringHuman-readable label
... subject Σ0..*Reference(Patient | Device | Practitioner | PractitionerRole | Location | HealthcareService | Organization)The entity that caused the expenses

... servicePeriod Σ0..1PeriodTransaction window
... coverage Σ0..*BackboneElementThe party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account

.... coverage Σ1..1Reference(Coverage)The party(s), such as insurances, that may contribute to the payment of this account
.... priority Σ0..1positiveIntThe priority of the coverage in the context of this account
... owner Σ0..1Reference(Organization)Entity managing the Account
... description Σ0..1markdownExplanation of purpose/use
... guarantor 0..*BackboneElementThe parties ultimately responsible for balancing the Account

.... party 1..1Reference(Patient | RelatedPerson | Organization)Responsible entity
.... onHold 0..1booleanCredit or other hold applied
.... period 0..1PeriodGuarantee account during
... diagnosis ΣCTU0..*BackboneElementThe list of diagnoses relevant to this account
+ Rule: The dateOfDiagnosis is not valid when using a reference to a diagnosis

.... sequence 0..1positiveIntRanking of the diagnosis (for each type)
.... condition ΣC1..1CodeableReference(Condition)The diagnosis relevant to the account
Binding: Condition/Problem/Diagnosis Codes (Example)
.... dateOfDiagnosis C0..1dateTimeDate of the diagnosis (when coded diagnosis)
.... type 0..*CodeableConceptType that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)
Binding: Encounter Diagnosis Use (Preferred)

.... onAdmission 0..1booleanDiagnosis present on Admission
.... packageCode 0..*CodeableConceptPackage Code specific for billing
Binding: diagnosis-package-code (Example)

... procedure ΣCTU0..*BackboneElementThe list of procedures relevant to this account
+ Rule: The dateOfService is not valid when using a reference to a procedure

.... sequence 0..1positiveIntRanking of the procedure (for each type)
.... code ΣC1..1CodeableReference(Procedure)The procedure relevant to the account
Binding: Procedure Codes (SNOMED CT) (Example)
.... dateOfService C0..1dateTimeDate of the procedure (when coded procedure)
.... type 0..*CodeableConceptHow this procedure value should be used in charging the account
Binding: procedure-type (Example)

.... packageCode 0..*CodeableConceptPackage Code specific for billing
Binding: procedure-package-code (Example)

.... device Σ0..*Reference(Device)Any devices that were associated with the procedure

... relatedAccount 0..*BackboneElementOther associated accounts related to this account

.... relationship 0..1CodeableConceptRelationship of the associated Account
Binding: Account Relationship (Example)
.... account 1..1Reference(Account)Reference to an associated Account
... currency 0..1CodeableConceptThe base or default currency
Binding: Currencies (Required)
... balance 0..*BackboneElementCalculated account balance(s)

.... aggregate 0..1CodeableConceptWho is expected to pay this part of the balance
Binding: Account Aggregate (Extensible)
.... term 0..1CodeableConceptcurrent | 30 | 60 | 90 | 120
Binding: Account Balance Term (Extensible)
.... estimate 0..1booleanEstimated balance
.... amount 1..1MoneyCalculated amount
... calculatedAt 0..1instantTime the balance amount was calculated

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

Account (DomainResource)Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number)identifier : Identifier [0..*]Indicates whether the account is presently used/usable or not (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)AccountStatus! »The BillingStatus tracks the lifecycle of the account through the billing process. It indicates how transactions are treated when they are allocated to the accountbillingStatus : CodeableConcept [0..1] « null (Strength=Example)AccountBillingStatus?? »Categorizes the account for reporting and searching purposestype : CodeableConcept [0..1] « null (Strength=Example)AccountTypes?? »Name used for the account when displaying it to humans in reports, etcname : string [0..1]Identifies the entity which incurs the expenses. While the immediate recipients of services or goods might be entities related to the subject, the expenses were ultimately incurred by the subject of the Accountsubject : Reference [0..*] « Patient|Device|Practitioner| PractitionerRole|Location|HealthcareService|Organization »The date range of services associated with this accountservicePeriod : Period [0..1]Indicates the service area, hospital, department, etc. with responsibility for managing the Accountowner : Reference [0..1] « Organization »Provides additional information about what the account tracks and how it is useddescription : markdown [0..1]The default currency for the accountcurrency : CodeableConcept [0..1] « null (Strength=Required)Currencies! »Time the balance amount was calculatedcalculatedAt : instant [0..1]CoverageThe party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay). A coverage may only be responsible for specific types of charges, and the sequence of the coverages in the account could be important when processing billingcoverage : Reference [1..1] « Coverage »The priority of the coverage in the context of this accountpriority : positiveInt [0..1]GuarantorThe entity who is responsibleparty : Reference [1..1] « Patient|RelatedPerson|Organization »A guarantor may be placed on credit hold or otherwise have their role temporarily suspendedonHold : boolean [0..1]The timeframe during which the guarantor accepts responsibility for the accountperiod : Period [0..1]DiagnosisRanking of the diagnosis (for each type)sequence : positiveInt [0..1]The diagnosis relevant to the accountcondition : CodeableReference [1..1] « Condition; null (Strength=Example) ConditionProblemDiagnosisCodes?? » « This element has or is affected by some invariantsC »Ranking of the diagnosis (for each type)dateOfDiagnosis : dateTime [0..1] « This element has or is affected by some invariantsC »Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)type : CodeableConcept [0..*] « null (Strength=Preferred)EncounterDiagnosisUse? »Was the Diagnosis present on Admission in the related EncounteronAdmission : boolean [0..1]The package code can be used to group diagnoses that may be priced or delivered as a single product. Such as DRGspackageCode : CodeableConcept [0..*] « null (Strength=Example)diagnosis-package-code?? »ProcedureRanking of the procedure (for each type)sequence : positiveInt [0..1]The procedure relevant to the accountcode : CodeableReference [1..1] « Procedure; null (Strength=Example)ProcedureCodesSNOMEDCT?? » « This element has or is affected by some invariantsC »Date of the procedure when using a coded procedure. If using a reference to a procedure, then the date on the procedure should be useddateOfService : dateTime [0..1] « This element has or is affected by some invariantsC »How this procedure value should be used in charging the accounttype : CodeableConcept [0..*] « null (Strength=Example)procedure-type?? »The package code can be used to group procedures that may be priced or delivered as a single product. Such as DRGspackageCode : CodeableConcept [0..*] « null (Strength=Example)procedure-package-code?? »Any devices that were associated with the procedure relevant to the accountdevice : Reference [0..*] « Device »RelatedAccountRelationship of the associated Accountrelationship : CodeableConcept [0..1] « null (Strength=Example)AccountRelationship?? »Reference to an associated Accountaccount : Reference [1..1] « Account »BalanceWho is expected to pay this part of the balanceaggregate : CodeableConcept [0..1] « null (Strength=Extensible)AccountAggregate+ »The term of the account balances - The balance value is the amount that was outstanding for this ageterm : CodeableConcept [0..1] « null (Strength=Extensible)AccountBalanceTerm+ »The amount is only an estimated value - this is likely common for `current` term balances, but not with known terms (that were generated by a backend process)estimate : boolean [0..1]The actual balance value calculated for the age defined in the term propertyamount : Money [1..1]The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the accountcoverage[0..*]The parties responsible for balancing the account if other payment options fall shortguarantor[0..*]When using an account for billing a specific Encounter the set of diagnoses that are relevant for billing are stored here on the account where they are able to be sequenced appropriately prior to processing to produce claim(s)diagnosis[0..*]When using an account for billing a specific Encounter the set of procedures that are relevant for billing are stored here on the account where they are able to be sequenced appropriately prior to processing to produce claim(s)procedure[0..*]Other associated accounts related to this accountrelatedAccount[0..*]The calculated account balances - these are calculated and processed by the finance system. The balances with a `term` that is not current are usually generated/updated by an invoicing or similar processbalance[0..*]

XML Template

<Account xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Account number --></identifier>
 <status value="[code]"/><!-- 1..1 active | inactive | entered-in-error | on-hold | unknown -->
 <billingStatus><!-- 0..1 CodeableConcept Tracks the lifecycle of the account through the billing process --></billingStatus>
 <type><!-- 0..1 CodeableConcept E.g. patient, expense, depreciation --></type>
 <name value="[string]"/><!-- 0..1 Human-readable label -->
 <subject><!-- 0..* Reference(Device|HealthcareService|Location|Organization|
   Patient|Practitioner|PractitionerRole) The entity that caused the expenses --></subject>
 <servicePeriod><!-- 0..1 Period Transaction window --></servicePeriod>
 <coverage>  <!-- 0..* The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account -->
  <coverage><!-- 1..1 Reference(Coverage) The party(s), such as insurances, that may contribute to the payment of this account --></coverage>
  <priority value="[positiveInt]"/><!-- 0..1 The priority of the coverage in the context of this account -->
 </coverage>
 <owner><!-- 0..1 Reference(Organization) Entity managing the Account --></owner>
 <description value="[markdown]"/><!-- 0..1 Explanation of purpose/use -->
 <guarantor>  <!-- 0..* The parties ultimately responsible for balancing the Account -->
  <party><!-- 1..1 Reference(Organization|Patient|RelatedPerson) Responsible entity --></party>
  <onHold value="[boolean]"/><!-- 0..1 Credit or other hold applied -->
  <period><!-- 0..1 Period Guarantee account during --></period>
 </guarantor>
 <diagnosis>  <!-- 0..* The list of diagnoses relevant to this account -->
  <sequence value="[positiveInt]"/><!-- 0..1 Ranking of the diagnosis (for each type) -->
  <condition><!-- I 1..1 CodeableReference(Condition) The diagnosis relevant to the account --></condition>
  <dateOfDiagnosis value="[dateTime]"/><!-- I 0..1 Date of the diagnosis (when coded diagnosis) -->
  <type><!-- 0..* CodeableConcept Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …) --></type>
  <onAdmission value="[boolean]"/><!-- 0..1 Diagnosis present on Admission -->
  <packageCode><!-- 0..* CodeableConcept Package Code specific for billing --></packageCode>
 </diagnosis>
 <procedure>  <!-- 0..* The list of procedures relevant to this account -->
  <sequence value="[positiveInt]"/><!-- 0..1 Ranking of the procedure (for each type) -->
  <code><!-- I 1..1 CodeableReference(Procedure) The procedure relevant to the account --></code>
  <dateOfService value="[dateTime]"/><!-- I 0..1 Date of the procedure (when coded procedure) -->
  <type><!-- 0..* CodeableConcept How this procedure value should be used in charging the account --></type>
  <packageCode><!-- 0..* CodeableConcept Package Code specific for billing --></packageCode>
  <device><!-- 0..* Reference(Device) Any devices that were associated with the procedure --></device>
 </procedure>
 <relatedAccount>  <!-- 0..* Other associated accounts related to this account -->
  <relationship><!-- 0..1 CodeableConcept Relationship of the associated Account --></relationship>
  <account><!-- 1..1 Reference(Account) Reference to an associated Account --></account>
 </relatedAccount>
 <currency><!-- 0..1 CodeableConcept The base or default currency --></currency>
 <balance>  <!-- 0..* Calculated account balance(s) -->
  <aggregate><!-- 0..1 CodeableConcept Who is expected to pay this part of the balance --></aggregate>
  <term><!-- 0..1 CodeableConcept current | 30 | 60 | 90 | 120 --></term>
  <estimate value="[boolean]"/><!-- 0..1 Estimated balance -->
  <amount><!-- 1..1 Money Calculated amount --></amount>
 </balance>
 <calculatedAt value="[instant]"/><!-- 0..1 Time the balance amount was calculated -->
</Account>

JSON Template

{doco
  "resourceType" : "Account",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Account number
  "status" : "<code>", // R!  active | inactive | entered-in-error | on-hold | unknown
  "billingStatus" : { CodeableConcept }, // Tracks the lifecycle of the account through the billing process
  "type" : { CodeableConcept }, // E.g. patient, expense, depreciation
  "name" : "<string>", // Human-readable label
  "subject" : [{ Reference(Device|HealthcareService|Location|Organization|
   Patient|Practitioner|PractitionerRole) }], // The entity that caused the expenses
  "servicePeriod" : { Period }, // Transaction window
  "coverage" : [{ // The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
    "coverage" : { Reference(Coverage) }, // R!  The party(s), such as insurances, that may contribute to the payment of this account
    "priority" : "<positiveInt>" // The priority of the coverage in the context of this account
  }],
  "owner" : { Reference(Organization) }, // Entity managing the Account
  "description" : "<markdown>", // Explanation of purpose/use
  "guarantor" : [{ // The parties ultimately responsible for balancing the Account
    "party" : { Reference(Organization|Patient|RelatedPerson) }, // R!  Responsible entity
    "onHold" : <boolean>, // Credit or other hold applied
    "period" : { Period } // Guarantee account during
  }],
  "diagnosis" : [{ // The list of diagnoses relevant to this account
    "sequence" : "<positiveInt>", // Ranking of the diagnosis (for each type)
    "condition" : { CodeableReference(Condition) }, // I R!  The diagnosis relevant to the account
    "dateOfDiagnosis" : "<dateTime>", // I Date of the diagnosis (when coded diagnosis)
    "type" : [{ CodeableConcept }], // Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)
    "onAdmission" : <boolean>, // Diagnosis present on Admission
    "packageCode" : [{ CodeableConcept }] // Package Code specific for billing
  }],
  "procedure" : [{ // The list of procedures relevant to this account
    "sequence" : "<positiveInt>", // Ranking of the procedure (for each type)
    "code" : { CodeableReference(Procedure) }, // I R!  The procedure relevant to the account
    "dateOfService" : "<dateTime>", // I Date of the procedure (when coded procedure)
    "type" : [{ CodeableConcept }], // How this procedure value should be used in charging the account
    "packageCode" : [{ CodeableConcept }], // Package Code specific for billing
    "device" : [{ Reference(Device) }] // Any devices that were associated with the procedure
  }],
  "relatedAccount" : [{ // Other associated accounts related to this account
    "relationship" : { CodeableConcept }, // Relationship of the associated Account
    "account" : { Reference(Account) } // R!  Reference to an associated Account
  }],
  "currency" : { CodeableConcept }, // The base or default currency
  "balance" : [{ // Calculated account balance(s)
    "aggregate" : { CodeableConcept }, // Who is expected to pay this part of the balance
    "term" : { CodeableConcept }, // current | 30 | 60 | 90 | 120
    "estimate" : <boolean>, // Estimated balance
    "amount" : { Money } // R!  Calculated amount
  }],
  "calculatedAt" : "<instant>" // Time the balance amount was calculated
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Account;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Account number
  fhir:status [ code ] ; # 1..1 active | inactive | entered-in-error | on-hold | unknown
  fhir:billingStatus [ CodeableConcept ] ; # 0..1 Tracks the lifecycle of the account through the billing process
  fhir:type [ CodeableConcept ] ; # 0..1 E.g. patient, expense, depreciation
  fhir:name [ string ] ; # 0..1 Human-readable label
  fhir:subject  ( [ Reference(Device|HealthcareService|Location|Organization|Patient|Practitioner|
  PractitionerRole) ] ... ) ; # 0..* The entity that caused the expenses
  fhir:servicePeriod [ Period ] ; # 0..1 Transaction window
  fhir:coverage ( [ # 0..* The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
    fhir:coverage [ Reference(Coverage) ] ; # 1..1 The party(s), such as insurances, that may contribute to the payment of this account
    fhir:priority [ positiveInt ] ; # 0..1 The priority of the coverage in the context of this account
  ] ... ) ;
  fhir:owner [ Reference(Organization) ] ; # 0..1 Entity managing the Account
  fhir:description [ markdown ] ; # 0..1 Explanation of purpose/use
  fhir:guarantor ( [ # 0..* The parties ultimately responsible for balancing the Account
    fhir:party [ Reference(Organization|Patient|RelatedPerson) ] ; # 1..1 Responsible entity
    fhir:onHold [ boolean ] ; # 0..1 Credit or other hold applied
    fhir:period [ Period ] ; # 0..1 Guarantee account during
  ] ... ) ;
  fhir:diagnosis ( [ # 0..* The list of diagnoses relevant to this account
    fhir:sequence [ positiveInt ] ; # 0..1 Ranking of the diagnosis (for each type)
    fhir:condition [ CodeableReference(Condition) ] ; # 1..1 I The diagnosis relevant to the account
    fhir:dateOfDiagnosis [ dateTime ] ; # 0..1 I Date of the diagnosis (when coded diagnosis)
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)
    fhir:onAdmission [ boolean ] ; # 0..1 Diagnosis present on Admission
    fhir:packageCode  ( [ CodeableConcept ] ... ) ; # 0..* Package Code specific for billing
  ] ... ) ;
  fhir:procedure ( [ # 0..* The list of procedures relevant to this account
    fhir:sequence [ positiveInt ] ; # 0..1 Ranking of the procedure (for each type)
    fhir:code [ CodeableReference(Procedure) ] ; # 1..1 I The procedure relevant to the account
    fhir:dateOfService [ dateTime ] ; # 0..1 I Date of the procedure (when coded procedure)
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* How this procedure value should be used in charging the account
    fhir:packageCode  ( [ CodeableConcept ] ... ) ; # 0..* Package Code specific for billing
    fhir:device  ( [ Reference(Device) ] ... ) ; # 0..* Any devices that were associated with the procedure
  ] ... ) ;
  fhir:relatedAccount ( [ # 0..* Other associated accounts related to this account
    fhir:relationship [ CodeableConcept ] ; # 0..1 Relationship of the associated Account
    fhir:account [ Reference(Account) ] ; # 1..1 Reference to an associated Account
  ] ... ) ;
  fhir:currency [ CodeableConcept ] ; # 0..1 The base or default currency
  fhir:balance ( [ # 0..* Calculated account balance(s)
    fhir:aggregate [ CodeableConcept ] ; # 0..1 Who is expected to pay this part of the balance
    fhir:term [ CodeableConcept ] ; # 0..1 current | 30 | 60 | 90 | 120
    fhir:estimate [ boolean ] ; # 0..1 Estimated balance
    fhir:amount [ Money ] ; # 1..1 Calculated amount
  ] ... ) ;
  fhir:calculatedAt [ instant ] ; # 0..1 Time the balance amount was calculated
]

Changes from both R4 and R4B

Account
Account.billingStatus
  • Added Element
Account.description
  • Type changed from string to markdown
Account.diagnosis
  • Added Element
Account.diagnosis.sequence
  • Added Element
Account.diagnosis.condition
  • Added Mandatory Element
Account.diagnosis.dateOfDiagnosis
  • Added Element
Account.diagnosis.type
  • Added Element
Account.diagnosis.onAdmission
  • Added Element
Account.diagnosis.packageCode
  • Added Element
Account.procedure
  • Added Element
Account.procedure.sequence
  • Added Element
Account.procedure.code
  • Added Mandatory Element
Account.procedure.dateOfService
  • Added Element
Account.procedure.type
  • Added Element
Account.procedure.packageCode
  • Added Element
Account.procedure.device
  • Added Element
Account.relatedAccount
  • Added Element
Account.relatedAccount.relationship
  • Added Element
Account.relatedAccount.account
  • Moved from Account.partOf to account
  • Min Cardinality changed from 0 to 1
Account.currency
  • Added Element
Account.balance
  • Added Element
Account.balance.aggregate
  • Added Element
Account.balance.term
  • Added Element
Account.balance.estimate
  • Added Element
Account.balance.amount
  • Added Mandatory Element
Account.calculatedAt
  • Added Element

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Account TUDomainResourceTracks balance, charges, for patient or cost center

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierAccount number

... status ?!Σ1..1codeactive | inactive | entered-in-error | on-hold | unknown
Binding: Account Status (Required)
... billingStatus Σ0..1CodeableConceptTracks the lifecycle of the account through the billing process
Binding: Example Account Billing Statuses (Example)
... name Σ0..1stringHuman-readable label
... subject Σ0..*Reference(Patient | Device | Practitioner | PractitionerRole | Location | HealthcareService | Organization)The entity that caused the expenses

... servicePeriod Σ0..1PeriodTransaction window
... coverage Σ0..*BackboneElementThe party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account

.... coverage Σ1..1Reference(Coverage)The party(s), such as insurances, that may contribute to the payment of this account
.... priority Σ0..1positiveIntThe priority of the coverage in the context of this account
... owner Σ0..1Reference(Organization)Entity managing the Account
... description Σ0..1markdownExplanation of purpose/use
... guarantor 0..*BackboneElementThe parties ultimately responsible for balancing the Account

.... party 1..1Reference(Patient | RelatedPerson | Organization)Responsible entity
.... onHold 0..1booleanCredit or other hold applied
.... period 0..1PeriodGuarantee account during
... diagnosis ΣCTU0..*BackboneElementThe list of diagnoses relevant to this account
+ Rule: The dateOfDiagnosis is not valid when using a reference to a diagnosis

.... sequence 0..1positiveIntRanking of the diagnosis (for each type)
.... condition ΣC1..1CodeableReference(Condition)The diagnosis relevant to the account
Binding: Condition/Problem/Diagnosis Codes (Example)
.... dateOfDiagnosis C0..1dateTimeDate of the diagnosis (when coded diagnosis)
.... type 0..*CodeableConceptType that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)
Binding: Encounter Diagnosis Use (Preferred)

.... onAdmission 0..1booleanDiagnosis present on Admission
.... packageCode 0..*CodeableConceptPackage Code specific for billing
Binding: diagnosis-package-code (Example)

... procedure ΣCTU0..*BackboneElementThe list of procedures relevant to this account
+ Rule: The dateOfService is not valid when using a reference to a procedure

.... sequence 0..1positiveIntRanking of the procedure (for each type)
.... code ΣC1..1CodeableReference(Procedure)The procedure relevant to the account
Binding: Procedure Codes (SNOMED CT) (Example)
.... dateOfService C0..1dateTimeDate of the procedure (when coded procedure)
.... type 0..*CodeableConceptHow this procedure value should be used in charging the account
Binding: procedure-type (Example)

.... packageCode 0..*CodeableConceptPackage Code specific for billing
Binding: procedure-package-code (Example)

.... device Σ0..*Reference(Device)Any devices that were associated with the procedure

... relatedAccount 0..*BackboneElementOther associated accounts related to this account

.... relationship 0..1CodeableConceptRelationship of the associated Account
Binding: Account Relationship (Example)
.... account 1..1Reference(Account)Reference to an associated Account
... currency 0..1CodeableConceptThe base or default currency
Binding: Currencies (Required)
... balance 0..*BackboneElementCalculated account balance(s)

.... aggregate 0..1CodeableConceptWho is expected to pay this part of the balance
Binding: Account Aggregate (Extensible)
.... term 0..1CodeableConceptcurrent | 30 | 60 | 90 | 120
Binding: Account Balance Term (Extensible)
.... estimate 0..1booleanEstimated balance
.... amount 1..1MoneyCalculated amount
... calculatedAt 0..1instantTime the balance amount was calculated

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

Account (DomainResource)Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number)identifier : Identifier [0..*]Indicates whether the account is presently used/usable or not (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)AccountStatus! »The BillingStatus tracks the lifecycle of the account through the billing process. It indicates how transactions are treated when they are allocated to the accountbillingStatus : CodeableConcept [0..1] « null (Strength=Example)AccountBillingStatus?? »Categorizes the account for reporting and searching purposestype : CodeableConcept [0..1] « null (Strength=Example)AccountTypes?? »Name used for the account when displaying it to humans in reports, etcname : string [0..1]Identifies the entity which incurs the expenses. While the immediate recipients of services or goods might be entities related to the subject, the expenses were ultimately incurred by the subject of the Accountsubject : Reference [0..*] « Patient|Device|Practitioner| PractitionerRole|Location|HealthcareService|Organization »The date range of services associated with this accountservicePeriod : Period [0..1]Indicates the service area, hospital, department, etc. with responsibility for managing the Accountowner : Reference [0..1] « Organization »Provides additional information about what the account tracks and how it is useddescription : markdown [0..1]The default currency for the accountcurrency : CodeableConcept [0..1] « null (Strength=Required)Currencies! »Time the balance amount was calculatedcalculatedAt : instant [0..1]CoverageThe party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay). A coverage may only be responsible for specific types of charges, and the sequence of the coverages in the account could be important when processing billingcoverage : Reference [1..1] « Coverage »The priority of the coverage in the context of this accountpriority : positiveInt [0..1]GuarantorThe entity who is responsibleparty : Reference [1..1] « Patient|RelatedPerson|Organization »A guarantor may be placed on credit hold or otherwise have their role temporarily suspendedonHold : boolean [0..1]The timeframe during which the guarantor accepts responsibility for the accountperiod : Period [0..1]DiagnosisRanking of the diagnosis (for each type)sequence : positiveInt [0..1]The diagnosis relevant to the accountcondition : CodeableReference [1..1] « Condition; null (Strength=Example) ConditionProblemDiagnosisCodes?? » « This element has or is affected by some invariantsC »Ranking of the diagnosis (for each type)dateOfDiagnosis : dateTime [0..1] « This element has or is affected by some invariantsC »Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)type : CodeableConcept [0..*] « null (Strength=Preferred)EncounterDiagnosisUse? »Was the Diagnosis present on Admission in the related EncounteronAdmission : boolean [0..1]The package code can be used to group diagnoses that may be priced or delivered as a single product. Such as DRGspackageCode : CodeableConcept [0..*] « null (Strength=Example)diagnosis-package-code?? »ProcedureRanking of the procedure (for each type)sequence : positiveInt [0..1]The procedure relevant to the accountcode : CodeableReference [1..1] « Procedure; null (Strength=Example)ProcedureCodesSNOMEDCT?? » « This element has or is affected by some invariantsC »Date of the procedure when using a coded procedure. If using a reference to a procedure, then the date on the procedure should be useddateOfService : dateTime [0..1] « This element has or is affected by some invariantsC »How this procedure value should be used in charging the accounttype : CodeableConcept [0..*] « null (Strength=Example)procedure-type?? »The package code can be used to group procedures that may be priced or delivered as a single product. Such as DRGspackageCode : CodeableConcept [0..*] « null (Strength=Example)procedure-package-code?? »Any devices that were associated with the procedure relevant to the accountdevice : Reference [0..*] « Device »RelatedAccountRelationship of the associated Accountrelationship : CodeableConcept [0..1] « null (Strength=Example)AccountRelationship?? »Reference to an associated Accountaccount : Reference [1..1] « Account »BalanceWho is expected to pay this part of the balanceaggregate : CodeableConcept [0..1] « null (Strength=Extensible)AccountAggregate+ »The term of the account balances - The balance value is the amount that was outstanding for this ageterm : CodeableConcept [0..1] « null (Strength=Extensible)AccountBalanceTerm+ »The amount is only an estimated value - this is likely common for `current` term balances, but not with known terms (that were generated by a backend process)estimate : boolean [0..1]The actual balance value calculated for the age defined in the term propertyamount : Money [1..1]The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the accountcoverage[0..*]The parties responsible for balancing the account if other payment options fall shortguarantor[0..*]When using an account for billing a specific Encounter the set of diagnoses that are relevant for billing are stored here on the account where they are able to be sequenced appropriately prior to processing to produce claim(s)diagnosis[0..*]When using an account for billing a specific Encounter the set of procedures that are relevant for billing are stored here on the account where they are able to be sequenced appropriately prior to processing to produce claim(s)procedure[0..*]Other associated accounts related to this accountrelatedAccount[0..*]The calculated account balances - these are calculated and processed by the finance system. The balances with a `term` that is not current are usually generated/updated by an invoicing or similar processbalance[0..*]

XML Template

<Account xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Account number --></identifier>
 <status value="[code]"/><!-- 1..1 active | inactive | entered-in-error | on-hold | unknown -->
 <billingStatus><!-- 0..1 CodeableConcept Tracks the lifecycle of the account through the billing process --></billingStatus>
 <type><!-- 0..1 CodeableConcept E.g. patient, expense, depreciation --></type>
 <name value="[string]"/><!-- 0..1 Human-readable label -->
 <subject><!-- 0..* Reference(Device|HealthcareService|Location|Organization|
   Patient|Practitioner|PractitionerRole) The entity that caused the expenses --></subject>
 <servicePeriod><!-- 0..1 Period Transaction window --></servicePeriod>
 <coverage>  <!-- 0..* The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account -->
  <coverage><!-- 1..1 Reference(Coverage) The party(s), such as insurances, that may contribute to the payment of this account --></coverage>
  <priority value="[positiveInt]"/><!-- 0..1 The priority of the coverage in the context of this account -->
 </coverage>
 <owner><!-- 0..1 Reference(Organization) Entity managing the Account --></owner>
 <description value="[markdown]"/><!-- 0..1 Explanation of purpose/use -->
 <guarantor>  <!-- 0..* The parties ultimately responsible for balancing the Account -->
  <party><!-- 1..1 Reference(Organization|Patient|RelatedPerson) Responsible entity --></party>
  <onHold value="[boolean]"/><!-- 0..1 Credit or other hold applied -->
  <period><!-- 0..1 Period Guarantee account during --></period>
 </guarantor>
 <diagnosis>  <!-- 0..* The list of diagnoses relevant to this account -->
  <sequence value="[positiveInt]"/><!-- 0..1 Ranking of the diagnosis (for each type) -->
  <condition><!-- I 1..1 CodeableReference(Condition) The diagnosis relevant to the account --></condition>
  <dateOfDiagnosis value="[dateTime]"/><!-- I 0..1 Date of the diagnosis (when coded diagnosis) -->
  <type><!-- 0..* CodeableConcept Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …) --></type>
  <onAdmission value="[boolean]"/><!-- 0..1 Diagnosis present on Admission -->
  <packageCode><!-- 0..* CodeableConcept Package Code specific for billing --></packageCode>
 </diagnosis>
 <procedure>  <!-- 0..* The list of procedures relevant to this account -->
  <sequence value="[positiveInt]"/><!-- 0..1 Ranking of the procedure (for each type) -->
  <code><!-- I 1..1 CodeableReference(Procedure) The procedure relevant to the account --></code>
  <dateOfService value="[dateTime]"/><!-- I 0..1 Date of the procedure (when coded procedure) -->
  <type><!-- 0..* CodeableConcept How this procedure value should be used in charging the account --></type>
  <packageCode><!-- 0..* CodeableConcept Package Code specific for billing --></packageCode>
  <device><!-- 0..* Reference(Device) Any devices that were associated with the procedure --></device>
 </procedure>
 <relatedAccount>  <!-- 0..* Other associated accounts related to this account -->
  <relationship><!-- 0..1 CodeableConcept Relationship of the associated Account --></relationship>
  <account><!-- 1..1 Reference(Account) Reference to an associated Account --></account>
 </relatedAccount>
 <currency><!-- 0..1 CodeableConcept The base or default currency --></currency>
 <balance>  <!-- 0..* Calculated account balance(s) -->
  <aggregate><!-- 0..1 CodeableConcept Who is expected to pay this part of the balance --></aggregate>
  <term><!-- 0..1 CodeableConcept current | 30 | 60 | 90 | 120 --></term>
  <estimate value="[boolean]"/><!-- 0..1 Estimated balance -->
  <amount><!-- 1..1 Money Calculated amount --></amount>
 </balance>
 <calculatedAt value="[instant]"/><!-- 0..1 Time the balance amount was calculated -->
</Account>

JSON Template

{doco
  "resourceType" : "Account",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Account number
  "status" : "<code>", // R!  active | inactive | entered-in-error | on-hold | unknown
  "billingStatus" : { CodeableConcept }, // Tracks the lifecycle of the account through the billing process
  "type" : { CodeableConcept }, // E.g. patient, expense, depreciation
  "name" : "<string>", // Human-readable label
  "subject" : [{ Reference(Device|HealthcareService|Location|Organization|
   Patient|Practitioner|PractitionerRole) }], // The entity that caused the expenses
  "servicePeriod" : { Period }, // Transaction window
  "coverage" : [{ // The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
    "coverage" : { Reference(Coverage) }, // R!  The party(s), such as insurances, that may contribute to the payment of this account
    "priority" : "<positiveInt>" // The priority of the coverage in the context of this account
  }],
  "owner" : { Reference(Organization) }, // Entity managing the Account
  "description" : "<markdown>", // Explanation of purpose/use
  "guarantor" : [{ // The parties ultimately responsible for balancing the Account
    "party" : { Reference(Organization|Patient|RelatedPerson) }, // R!  Responsible entity
    "onHold" : <boolean>, // Credit or other hold applied
    "period" : { Period } // Guarantee account during
  }],
  "diagnosis" : [{ // The list of diagnoses relevant to this account
    "sequence" : "<positiveInt>", // Ranking of the diagnosis (for each type)
    "condition" : { CodeableReference(Condition) }, // I R!  The diagnosis relevant to the account
    "dateOfDiagnosis" : "<dateTime>", // I Date of the diagnosis (when coded diagnosis)
    "type" : [{ CodeableConcept }], // Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)
    "onAdmission" : <boolean>, // Diagnosis present on Admission
    "packageCode" : [{ CodeableConcept }] // Package Code specific for billing
  }],
  "procedure" : [{ // The list of procedures relevant to this account
    "sequence" : "<positiveInt>", // Ranking of the procedure (for each type)
    "code" : { CodeableReference(Procedure) }, // I R!  The procedure relevant to the account
    "dateOfService" : "<dateTime>", // I Date of the procedure (when coded procedure)
    "type" : [{ CodeableConcept }], // How this procedure value should be used in charging the account
    "packageCode" : [{ CodeableConcept }], // Package Code specific for billing
    "device" : [{ Reference(Device) }] // Any devices that were associated with the procedure
  }],
  "relatedAccount" : [{ // Other associated accounts related to this account
    "relationship" : { CodeableConcept }, // Relationship of the associated Account
    "account" : { Reference(Account) } // R!  Reference to an associated Account
  }],
  "currency" : { CodeableConcept }, // The base or default currency
  "balance" : [{ // Calculated account balance(s)
    "aggregate" : { CodeableConcept }, // Who is expected to pay this part of the balance
    "term" : { CodeableConcept }, // current | 30 | 60 | 90 | 120
    "estimate" : <boolean>, // Estimated balance
    "amount" : { Money } // R!  Calculated amount
  }],
  "calculatedAt" : "<instant>" // Time the balance amount was calculated
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Account;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Account number
  fhir:status [ code ] ; # 1..1 active | inactive | entered-in-error | on-hold | unknown
  fhir:billingStatus [ CodeableConcept ] ; # 0..1 Tracks the lifecycle of the account through the billing process
  fhir:type [ CodeableConcept ] ; # 0..1 E.g. patient, expense, depreciation
  fhir:name [ string ] ; # 0..1 Human-readable label
  fhir:subject  ( [ Reference(Device|HealthcareService|Location|Organization|Patient|Practitioner|
  PractitionerRole) ] ... ) ; # 0..* The entity that caused the expenses
  fhir:servicePeriod [ Period ] ; # 0..1 Transaction window
  fhir:coverage ( [ # 0..* The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
    fhir:coverage [ Reference(Coverage) ] ; # 1..1 The party(s), such as insurances, that may contribute to the payment of this account
    fhir:priority [ positiveInt ] ; # 0..1 The priority of the coverage in the context of this account
  ] ... ) ;
  fhir:owner [ Reference(Organization) ] ; # 0..1 Entity managing the Account
  fhir:description [ markdown ] ; # 0..1 Explanation of purpose/use
  fhir:guarantor ( [ # 0..* The parties ultimately responsible for balancing the Account
    fhir:party [ Reference(Organization|Patient|RelatedPerson) ] ; # 1..1 Responsible entity
    fhir:onHold [ boolean ] ; # 0..1 Credit or other hold applied
    fhir:period [ Period ] ; # 0..1 Guarantee account during
  ] ... ) ;
  fhir:diagnosis ( [ # 0..* The list of diagnoses relevant to this account
    fhir:sequence [ positiveInt ] ; # 0..1 Ranking of the diagnosis (for each type)
    fhir:condition [ CodeableReference(Condition) ] ; # 1..1 I The diagnosis relevant to the account
    fhir:dateOfDiagnosis [ dateTime ] ; # 0..1 I Date of the diagnosis (when coded diagnosis)
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)
    fhir:onAdmission [ boolean ] ; # 0..1 Diagnosis present on Admission
    fhir:packageCode  ( [ CodeableConcept ] ... ) ; # 0..* Package Code specific for billing
  ] ... ) ;
  fhir:procedure ( [ # 0..* The list of procedures relevant to this account
    fhir:sequence [ positiveInt ] ; # 0..1 Ranking of the procedure (for each type)
    fhir:code [ CodeableReference(Procedure) ] ; # 1..1 I The procedure relevant to the account
    fhir:dateOfService [ dateTime ] ; # 0..1 I Date of the procedure (when coded procedure)
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* How this procedure value should be used in charging the account
    fhir:packageCode  ( [ CodeableConcept ] ... ) ; # 0..* Package Code specific for billing
    fhir:device  ( [ Reference(Device) ] ... ) ; # 0..* Any devices that were associated with the procedure
  ] ... ) ;
  fhir:relatedAccount ( [ # 0..* Other associated accounts related to this account
    fhir:relationship [ CodeableConcept ] ; # 0..1 Relationship of the associated Account
    fhir:account [ Reference(Account) ] ; # 1..1 Reference to an associated Account
  ] ... ) ;
  fhir:currency [ CodeableConcept ] ; # 0..1 The base or default currency
  fhir:balance ( [ # 0..* Calculated account balance(s)
    fhir:aggregate [ CodeableConcept ] ; # 0..1 Who is expected to pay this part of the balance
    fhir:term [ CodeableConcept ] ; # 0..1 current | 30 | 60 | 90 | 120
    fhir:estimate [ boolean ] ; # 0..1 Estimated balance
    fhir:amount [ Money ] ; # 1..1 Calculated amount
  ] ... ) ;
  fhir:calculatedAt [ instant ] ; # 0..1 Time the balance amount was calculated
]

Changes from both R4 and R4B

Account
Account.billingStatus
  • Added Element
Account.description
  • Type changed from string to markdown
Account.diagnosis
  • Added Element
Account.diagnosis.sequence
  • Added Element
Account.diagnosis.condition
  • Added Mandatory Element
Account.diagnosis.dateOfDiagnosis
  • Added Element
Account.diagnosis.type
  • Added Element
Account.diagnosis.onAdmission
  • Added Element
Account.diagnosis.packageCode
  • Added Element
Account.procedure
  • Added Element
Account.procedure.sequence
  • Added Element
Account.procedure.code
  • Added Mandatory Element
Account.procedure.dateOfService
  • Added Element
Account.procedure.type
  • Added Element
Account.procedure.packageCode
  • Added Element
Account.procedure.device
  • Added Element
Account.relatedAccount
  • Added Element
Account.relatedAccount.relationship
  • Added Element
Account.relatedAccount.account
  • Moved from Account.partOf to account
  • Min Cardinality changed from 0 to 1
Account.currency
  • Added Element
Account.balance
  • Added Element
Account.balance.aggregate
  • Added Element
Account.balance.term
  • Added Element
Account.balance.estimate
  • Added Element
Account.balance.amount
  • Added Mandatory Element
Account.calculatedAt
  • Added Element

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

8.13.5.1 Terminology Bindings

PathValueSetTypeDocumentation
Account.status AccountStatus Required

Indicates whether the account is available to be used.
Account.billingStatus AccountBillingStatus (a valid code from Example Account Billing Statuses)Example

Indicates whether the account is available to be used for billing purposes.
Account.type AccountTypes Example

This examples value set defines the set of codes that can be used to represent the type of an account.
Account.diagnosis.condition ConditionProblemDiagnosisCodes Example

Example value set for Condition/Problem/Diagnosis codes.
Account.diagnosis.type EncounterDiagnosisUse Preferred

What a specific Encounter/EpisodeOfCare diagnosis.condition is to be used for.
Account.diagnosis.packageCode ??Example
Account.procedure.code ProcedureCodesSNOMEDCT Example

Procedure Code: All SNOMED CT procedure codes.
Account.procedure.type ??Example
Account.procedure.packageCode ??Example
Account.relatedAccount.relationship AccountRelationship Example

Relationship between accounts
Account.currency Currencies (a valid code from urn:iso:std:iso:4217)Required

Currency codes from ISO 4217 (see https://www.iso.org/iso-4217-currency-codes.html)
Account.balance.aggregate AccountAggregate Extensible

Indicates who is expected to pay a part of the account balance.
Account.balance.term AccountBalanceTerm Extensible

Indicates the account balance's age.

8.13.5.2 Constraints

UniqueKeyLevelLocationDescriptionExpression
img act-1Rule Account.diagnosisThe dateOfDiagnosis is not valid when using a reference to a diagnosiscondition.reference.empty().not() implies dateOfDiagnosis.empty()
img act-2Rule Account.procedureThe dateOfService is not valid when using a reference to a procedurecode.reference.empty().not() implies dateOfService.empty()

8.13.6 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
guarantorreferenceThe parties ultimately responsible for balancing the AccountAccount.guarantor.party
(Organization, Patient, RelatedPerson)
identifiertokenAccount numberAccount.identifier65 Resources
namestringHuman-readable labelAccount.name
ownerreferenceEntity managing the AccountAccount.owner
(Organization)
patientreferenceThe entity that caused the expensesAccount.subject.where(resolve() is Patient)
(Patient)		66 Resources
perioddateTransaction windowAccount.servicePeriod
relatedaccountreferenceParent and other related accountsAccount.relatedAccount.account
(Account)
statustokenactive | inactive | entered-in-error | on-hold | unknownAccount.status
subjectreferenceThe entity that caused the expensesAccount.subject
(Practitioner, Organization, Device, Patient, HealthcareService, PractitionerRole, Location)
typetokenE.g. patient, expense, depreciationAccount.type11 Resources